Social-cognitive signatures of autism are independent of gender identity: Evidence from theory of mind and alexithymia in youth and caregivers

Some argue that autism in gender-diverse people may reflect the effects of gender-related distress and minority stress producing autism-like features, rather than biologically based neurodiversity. We tested key predictions stemming from this "phenocopy" account by examining whether autism-related cognitive characteristics would track gender identity (cisgender/gender diverse) rather than autism diagnosis. Specifically, the phenocopy account predicts that the behavioral features of autism in gender-diverse people are superficial and therefore will not be accompanied by an autism-typical cognitive profile. We tested this in a 2 (diagnostic status: autistic vs. non-autistic) × 2 (gender identity status: cisgender vs. gender diverse) design, for which data collection ran from March 2023 to March 2025 and took part exclusively in the United Kingdom. In Study 1, 181 matched youth (aged 7-16 years; 89% White) completed theory of mind (ToM) measures, and alexithymia was assessed via parental report. In Study 2, 202 caregivers (aged 28-62 years; 96% White) completed similar measures. Autistic youth showed lower ToM (ηp2 = .07) and higher alexithymia (ηp2 ≥ .09), irrespective of gender identity. Caregivers of autistic youth exhibited higher alexithymia (ηp2 = .04), but no ToM differences (ηp2 ≤ .01). The findings provide no evidence for the phenocopy account but can inform clinical support.